Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist |
NPI | 1578012498 |
---|---|
Provider Name | Andre Turner |
First Address | Upland, CA 91786 |
Second Address | Upland, CA 91786-5584 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2016 |
Last Update Date | 04/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
92085265A | HEALTH NET (01) |